2013, 11-14 Notice of Hazardous Conditions �ugV/STA'
NOTICE OF HAZARDOUS CONDITIONS S-0308(08-01)
Utilities
1
Customer Name Phone Number L
Address City
TYPE OF ❑ HAZARD The conditions noted below constitute an immediate hazard and may result in property damage,personal injury,or loss
NOTIFICATION: of life.The equipment has been disconnected or left inoperable,and shall not be turned back on until such repairs have been completed
by a qualified HVAC dealer,contractor,or service agency,and the equipment has been brought up to current safety standards.Do not
attempt to use this eauipment until it has been repaired.
Equipment Type: 1`,/► Location: -`/'�` tii ec
CONDITIONS ❑ Apparent cracked or restricted heat exchanger ❑ A gas leak in your house piping in the amount of CFH
FOUND: ❑ Damaged appliance connector with all known appliances off
❑ Damaged or disconnected vent Insufficient combustion/ventilation air j
❑ Gas leak at gas equipment Other
I
Meter Left 0 Off ❑ On Meter Number Meter Read
I have read,understood and acknowledge receipt of this notice. ❑ Owner ❑ Tenant ❑ Agent
Customer Signature ❑ Refused to Sign
( I -70/
Representative
0 O Date Time f am/
White Copy-Customer Yellow Copy-Attach to Service Order Pink Copy-Authority Having Jurisdiction Hard Copy-Appliance () \‘°
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Sdte- 41365 Group:
Ute: PLUMBING REVERSAL Dist F BOBBY STONE
Inyoice Status Fees 1 Payment History Billing 1 Bonds 1 Inspections Renewals I
Actions site Address Contacts I Team jlestones j Logs 1 Conditions Characteristics
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Bite Addiesses
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Owner Name Occupant Name!
Site Address I Address Address
Parcel Number City,State,Zip City-Stale-Zip City-Statelip
462/44214 13515 E 25111 AVE MC GILE.E,MARY ANN
SPOKANE,riA 99216 13616 E 28TH AVE
GIS U SPOKAttE,ItiA$218 SAME,WA 119216
Phone (509)926-0060
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Record: .14 1 I I 1 111-10f
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Monday, Dec 15,2003 03:04 PM